Children's Hospital of Pittsburgh of UPMC supports parents’ presence with children during resuscitation

Inviting parents to the bedside while their child receives CPR is supported by professional associations, joint position and policy statements, and clinical practice guidelines, but hospitals often find that putting those recommendations into practice requires more than a new policy.

An article in the June issue of Critical Care Nurse (CCN) describes how Children's Hospital of Pittsburgh of UPMC developed an interdisciplinary team in its pediatric intensive care unit (PICU) to support parents when their child requires CPR.

"Parents prefer to be given a choice to be with their children during resuscitation, even though having them present remains somewhat controversial among providers," said Tracy Ann Pasek, RN, MSN, DNP, CCNS, CCRN, CIMI, clinical nurse specialist in the PICU at Children's Hospital and lead author of the article in CCN. "Patient- and family-centered care is part of our culture at Children's Hospital, but we wanted to take an extra step to support families during their child's medical crisis."

The article, "Parent Advocacy Group for Events of Resuscitation," discusses the steps taken before the launch of the new initiative, including assessing the status quo and educating staff.

Children's Hospital Parent Advocacy Group for Events of Resuscitation (PAGER) aims to assure patients' families have the option of being with their child during CPR and are supported throughout the experience with skilled and sensitive care.

The group extends the capabilities of existing clinical social work staff by helping fulfill a need for critically ill children and their families during off-shifts and weekends and in situations when those resources may be limited or exhausted.

Before launching the initiative, the research team collected CPR data from all shifts in the hospital's 36-bed PICU during a 12-month period. Out of a total of eight incidents, families were given the option to be present for six CPR events and were supported by at least one provider during the medical crisis.

The investigators also surveyed PICU staff nurses about their attitudes toward providing family-sensitive care to families in crisis. The survey results were used to develop a two-hour class focused on how to assist families during a medical crisis. The class included role play and discussion to help participants prepare for their PAGER role. Participants also completed the hospital's self-defense course.

PAGER is composed of seven PICU staff nurses, a clinical social worker, a clinical nurse leader, a clinical nurse specialist and a physician who serves as a liaison to the critical care medicine division. More PICU nurses may join the group, and the initiative may also be expanded to the neonatal and cardiac ICUs.

PAGER members wear a special pin on their uniform to indicate their role as parent advocates during CPR.

Within a month after the program was officially launched, PAGER members facilitated parental presence during two CPR events. The nurses wrote summaries of their experiences to share with PICU staff, reflecting on challenges and emphasizing supportive reactions from their peers and the affected families.

Early implementation of the PAGER role has met with positive feedback from families and staff, finding that family presence did not impede the workflow of the providers, and the families appreciated the option of being present with their child.